LIVING WITH EPILEPSY: WHAT TO DO DURING A SEIZURE
Posted on December 9, 2009, under Epilepsy.
What should a bystander do during a grand mal attack? The onset is often so sudden that it is difficult to do much at all in the early stage, though it may be possible to break the person’s fall. Parents or other relatives may recognize the warning signs that may occur if the generalized seizure follows a focal discharge, and so may have time to help the person to a chair or to a bed before the grand mal begins.
Don’t try to open the person’s clenched mouth. The tongue, if bitten, is bitten at the onset of the attack, so there is no point in trying to save it. If the bystander uses his own fingers to try to force the mouth open, they may well be bitten in the clonic phase. If he tries to force a spoon or pencil between the teeth, the person’s teeth may be damaged. These manoeuvres are still sometimes attempted by tradition, and sometimes, presumably, because it is assumed that the person’s blue colour and arrest of breathing are due to obstruction to the passage of air into the lungs. Attempts to ‘loosen the collar’ presumably result from the same thoughts. However, all of us have enough gaps between our teeth to allow passage of air around them as readers can readily show for themselves by clenching their teeth, pinching the nose, and breathing in. Obstruction to the airway may occur during a seizure, if the person is lying on his back. The tongue may then fall backwards into the pharynx, and, for this reason, it is worth turning someone suffering a grand mal seizure into a position halfway between lying on his or her side and face, and thumping the back so that the tongue and any dentures fall forwards. This position also has the advantage that if the person vomits, as occasionally happens, the contents of the stomach pass easily out of the mouth, and there is no danger of vomit entering the trachea and lungs.
If a grand mal seizure occurs in a public place, it usually happens that someone calls an ambulance—very often to the annoyance of the person with epilepsy, who is well on the way to recovery by the time the ambulance driver delivers him to the local hospital. There is no need to call an ambulance unless it is clear that repeated seizures are occurring.
There is usually little to be done during a partial seizure, except to stand by in a reassuring manner until seizure activity ceases. Occasionally gentle restraint may be necessary in the case of complex automatic behaviour.
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MEDITATION FOR ANXIETY DISORDERS: STAGES OF MEDITATION
Posted on December 9, 2009, under Anti Depressants-Sleeping Aid.
There are various phases of the meditative process. Most people experience them in varying degrees. Some people become very worried about these experiences. Therefore it is important to discuss them.
The one experience people worry about is the sensation of their body relaxing. Sometimes people have been so tense for so many years they have forgotten what it is like to feel even slightly relaxed. As their bodies begin to let go of the tension, people become anxious and interpret the sensations as a sign that their worst fears are about to come true. They don’t.
The first stage of meditation can be difficult for beginners. Our thoughts are not used to being ignored and they continually break through and demand attention. As long as we can accept this as normal and let go of them without becoming frustrated, we can move into the second stage of meditation.
As we enter the second stage of meditation we feel the quiet settle over us. Our breathing begins to slow down. Our thoughts are still rising and falling, but our attention is now much more focused on our technique. Everything moves into the background as our quietness grows.
We enter the third stage. Our breathing slows down even further and our body becomes deeply relaxed. We may feel as if we are as light as a feather, or we may feel a comfortable heaviness. We become aware that the continuous stream of thoughts has broken. They now rise slowly and separate from each other. Individually, they quietly rise and fall without us becoming distracted by them. We find our word or mantra becomes distorted. This is what is supposed to happen. Some of us may see brilliant white, black or other swirls of colour. We can use them to take ourselves deeper. Our thoughts drift in and out, slowly and quietly.
We then enter the full meditative state in which there is perfect quietness, an absence of thought, feeling or emotions. Unlike the stages of deep sleep, this state of consciousness is very dynamic. There is full awareness of ‘nothing’, but in that ‘nothing’ is an awareness of ‘every-thing’. In this state there is no technique and no thoughts or feelings-just an all-pervasive quiet. Yet we are aware of everything and in full control. When we think ‘this is wonderful’ the quiet is broken by that thought, but we can return to the quiet simply by returning to our technique.
This is meditation.
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TREATMENT OF YOUR DEPRESSION: A DOCTOR AS A COMPANION
Posted on December 9, 2009, under Anti Depressants-Sleeping Aid.
In a recent article, the eminent doctor and author Sherwin Nuland writes about the deficiencies of modern medicine in which the doctor treats the disease but not the patient who is suffering from the illness. Being ill is a lonely and scary condition and, of all illnesses, depression must surely be one of the loneliest and scariest. A good doctor should be a source of comfort to you in your illness and in the recovery process. You would do well to invest the time and energy in finding a doctor who is not only technically competent but is also able to play this critical role.
Choosing a Doctor
I can’t emphasize enough how important is the choice of a doctor. I am often astonished by how some highly discriminating people, who are careful in the selection of their barber or hairdresser and will go to great lengths to buy the right car at the right price, will take pot luck with whatever doctor is in their neighbourhood. I always like to go to doctors recommended to me by other doctors, figuring that if you’re in the trade yourself, you know the wheat from the chaff.
Credentials are of some value in choosing a good doctor, but sometimes doctors trained at the best places can also be conceited and closed to new ideas. In seeking a doctor, find someone who is clever, up-to-date, sympathetic, open-minded and not too impressed with his or her own opinions. Find someone who will take the time to listen to you and really hear what you are saying. Finally, keep an eye on your doctor. Even the best doctors are only human, can make mistakes and don’t always think of all the possibilities. Even if you are in treatment with a good doctor, you still have some responsibility to use your wits to be sure that you get the best possible care.
Extricating Yourself from an Unsuitable Doctor
A good doctor should not only keep up with the literature but also be open to learning new things. Ignorance is human and often forgivable; it is, after all, a treatable condition. Closed-mindedness, however, is hard to treat and if your doctor is not open to new information, that is a real problem since medicine is constantly changing and new diagnostic and treatment approaches are regularly being developed. It can also be very distressing to end up with a doctor who, rightly or wrongly, reflexively dismisses your point of view, as illustrated by the following cautionary tale.
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ALCOHOLISM
We are so imbued with psychological explanations of alcoholism that it seems strange to consider this problem as related to food or chemical susceptibility. Frequently, however, an alcoholic is not a mentally sick person, in the conventional sense, but a very advanced food addict. In fact, alcoholism could well be called the acme, or pinnacle, of the food-addiction pyramid.
It is usually assumed that the alcoholic craves the ethyl alcohol in his drink. In most discussions of the problem, however, a significant fact is overlooked: few people would choose to drink pure ethyl alcohol, even if given the chance. Alcohol is almost invariably found mixed with other ingredients or fractions, many of them related to common foods. Starting in the mid-1940s, I began to accumulate evidence that it was principally these foods, rather than the alcohol itself, to which many alcoholics were addicted.
This insight was related to developments in food allergy. It was Herbert J. Rinkel, the same man who discovered “masking” and “unmasking” of food allergy, who first diagnosed allergies to corn, in the 1940s. I confirmed Rinkel’s observations in my patients, and together we published a series of lists of foods containing corn or corn products.
Allergy to corn turned out to be the most common food allergy in North America. Why, then, had its discovery waited until the 1940s, years after the other common allergies were described? The answer lay in the very fact of corn’s popularity. Because it was present in practically every meal in one form or another, obvious or disguised, it was extremely difficult to unmask. It was only when we had compiled a fairly complete list and ferreted out the corn in numerous products, in the form of corn syrup, corn starch, corn oil, and so forth, that we could perform adequate tests.
Soon after this, I began to notice that many of my alcoholic patients had corn allergies. Some patients, for example, told me that they became drunk on only one or two glasses of beer or a couple of shots of bourbon. Such patients were invariably highly susceptible to corn or to other ingredients in these beverages, such as wheat or yeast. It dawned on me that it might be these substances, rather than the alcohol per se, which perpetuated the craving for alcoholic beverages and which caused the bizarre behavioral changes associated with alcohol consumption. Since alcohol is rapidly absorbed into the bloodstream, it was likely that these food fractions were rapidly absorbed along with it, creating problems for the susceptible.
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SIGNS OF DEPRESSION: LIFE SEEMS NOT WORTH LIVING
Posted on December 9, 2009, under Anti Depressants-Sleeping Aid.
As you can imagine, with all the symptoms I have just listed, including a grim and bleak view of your present situation and future prospects, a depressed person may easily reach the conclusion – or entertain the possibility – that life is not worth living. This symptom of depression, known to the clinician as suicidal ideation, is a very troublesome one. If you are experiencing any such ideas, please do yourself and everyone who cares about you a great favour and consult a doctor without delay. Depression is a condition where hope is in short supply and one way to get an infusion of hope is to reach out to those who may be able to guide you out of the dark place. Your GP is a logical first port of call in such an attempt to reach out. But if, for any reason, it is difficult for you to talk to your doctor about the problem, tell someone – a family member, friend, or even someone on a crisis hot line. Suicidal ideation is not a symptom that anyone ought to have to suffer alone.
As depression deepens, suicidal ideation may progress to passive suicidal longings, which may be accompanied by lack of self-care or carelessness. A depressed woman may feel a lump in her breast while taking a shower and may say to herself, ‘So what if it’s cancer? It would probably be all for the best anyway’ Another depressed person might cross the road carelessly and, in the back of his mind, be thinking, ‘Well, if I get run over, what loss will that be to anyone?’
Matters become even more serious when suicidal ideas begin to gel into actual plans, and even more so when actions are taken to put these plans into effect. It might seem unnecessary to say that if someone you know or love should mention suicidal ideas or plans to you, these should always be taken seriously. Unfortunately it is still all too common for people to minimize the seriousness of such communications. The idea that if someone tells you he is considering suicide, he is unlikely to act on it, is a very dangerous myth. Such divulgences should always be heard as a communication of despair, which may or may not involve immediate danger but which always warrants serious attention. At the very least it is an expression of severe mental anguish.
If you think that life is not worth living or have any thoughts or plans to end your life, you are very, very likely to be depressed. Please don’t delay in getting professional help for this problem.
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THE TREATMENT OF EPILEPSY: SHOULD ANTI-EPILEPTIC MEDICATION BE GIVEN?
A person who has had two or three seizures does not necessarily need treatment. For example, an adult who has two or three generalized tonic-clonic seizures (grand mal fits) in a two-week period and who might lose his job if he had a seizure at work requires early treatment, whereas a child who has cerebral palsy and learning difficulties and who had had two partial seizures six months apart does not necessarily require treatment with anti-epileptic drugs. Remember also that there are people whose seizures can be clearly attributed in part to a non-recurring cause. For example, seizures may begin for the first time whilst the person is on an antidepressant drug, such as amitriptyline, which is known to induce seizures in some people. Clearly the drug is not the only factor. Thousands of people take amitriptyline without having seizures. In those who do, the drug presumably acts on those with a low seizure threshold. Nevertheless it would seem reasonable to see how such a person gets on without antidepressants, before prescribing anti-epileptic medication. Other precipitating factors, if specific, such as occur in epilepsy induced by television may be avoided, and make anti-epileptic medication unnecessary.
It is therefore important that each patient is considered as an individual. The choice of whether or not anti-epileptic medication should be used is made in equal partnership between patient (or parent) and doctor. For example, a woman may wish to avoid anti-epileptic medication if planning a pregnancy even though her chances of further seizures are high.
One common decision that has to be made is whether or not to start anti-epileptic medication after a single seizure in an adult, often for which no clearly defined precipitating factor can be identified. It used to be advised that ‘one seizure did not make a diagnosis of epilepsy’. Although true by definition, the risk of a second seizure is in adults as high as 78% over the next three years, the risk being its highest in the first few weeks. Recent trials have shown clearly that an anti-epileptic drug given after the first seizure does significantly reduce the chances of a second. Patients should be offered the choice of anti-epileptic medication at this stage, with a clear explanation of the risks of further seizures and the relative drawbacks of medication, even though a number will decide to take their chances.
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TESTS IN EPILEPSY: BRAIN IMAGING INVESTIGATIONS AND THE CT SCAN
The EEG is a ‘functional’ investigation, recording the brain’s function through normal and abnormal electrical activity. Imaging procedures or brain scans provide information about the brain’s structure, and revealing normal and abnormal anatomy. Most, if not all patients who have epilepsy need to have at least one EEG, fewer than perhaps 1 in 5 or 1 in 6 patients need to have an imaging investigation. Research is underway to determine who should be scanned.
Two types of imaging techniques are currently available in the developed world; these are the computerized tomographic (CT) brain scan and magnetic resonance imaging (MRI).
The CT scan-This is an abbreviation the computerized axial tomography (CAT) scan. The technique was developed in the 1970s and is a type of X-ray investigation. Tomography is a word dating from earlier X-ray techniques. The patient lies still on a table whilst a rotating X-ray machine takes two-dimensional pictures of the head from many different angles or positions. The information is then processed by a computer to produce pictures (or images) at different levels of the brain. The test is safe, and other than keeping the head still, there are no particular precautions to be taken. Children may have to be given a sedative drug or short anaesthetic so that they can keep still for the scan. The test takes approximately 15-20 minutes. If an area of interest is seen on the initial images, some contrast (special dye) is injected into a vein in the hand or arm and then the scan repeated. The dye may enhance contrast in areas of interest and give more detailed information. CT scanning has proved to be very useful in detecting structural abnormalities within the brain, such as strokes, infections, tumours, and congenital malformations which may cause epilepsy. However, only 20-25 per cent of patients with epilepsy referred to special centres will have an abnormal CT scan. Abnormalities on the CT scan in patients who have epilepsy are more likely to be found in the following situations:
• patients whose seizures affect only one side of the body;
• patients whose EEG shows a persistent slow wave abnormality on one side of the brain;
• when epilepsy starts in newborn babies and continues;
• when epilepsy starts in later life; and
• if the patient has abnormal findings on neurological examination, for example, mild weakness down one side of the body, or changes in the reflexes.
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THE FACTS ABOUT PROTEIN DIET
At the risk of disappointing many steak lovers, I must state that there is no scientific truth in the high-protein-for-health theory. If you are really concerned with your health and long life, you must unlearn everything you have learned previously concerning proteins.
It is true that our bodies are built mostly of proteins. Twenty per cent, and more in some vital organs, of a cell’s composition is made up of protein. Since our body is renewing and repairing its cells constantly, we need lots of protein in our diet to supply needed nutrients for these repairs and for the building of new cells.
But how much is “lots”? Seventy, 100, or 150 grams a day, as advocated by many American “experts”? Due to the frame of this work we cannot, unfortunately, go into great detail in presenting this most interesting subject. Suffice here to say that the majority of responsible nutritionists in various parts of the world agree that our present beliefs on the protein question are outdated and that the actual need for protein in the human diet is far below that which has long been considered necessary. The famous nutritionists Dr. Ragnar Berg, Dr. R. Chittenden, Dr. M. Hindhede, Dr. M. Hegsted, Dr. William C. Rose, and others are reported to have shown in extensive experiments that our actual need for protein is somewhere around 30 grams a day, or even less. Many leading contemporary scientists and nutritionists in Europe, such as Dr. Ralph Bircher, Dr. Otto Buchinger, Jr., Dr. H. Karstrom, Prof. H. A. Schweigart, Dr. Karl-Otto Aly, and many others are in full agreement with the findings of Drs. Berg, Chittenden, Rose, et al., and are recommending a low-protein diet as the diet most conducive to good health.
Empirical experience and observation proves the correctness of the above fact. The healthiest people in the world—the famous Hunza people in India, the Semitic tribes of Yemen, Bulgarians and Russians, certain tribes of Central America and Africa—which are known for their good health, long fife, and resistance to disease, all five on a low animal protein, high natural carbohydrate diet. Even in the United States, some religious groups, like the Seventh-Day Adventists and Mormons, who advocate a low animal protein diet, have 50 to 70 per cent lower death rates than those of average Americans; this is shown by statistics. They also are reported to have a much lower incidence of cancer, tuberculosis, coronary diseases, blood and kidney diseases, and diseases of the digestive and respiratory organs.
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A PRACTICAL GUIDE TO USING ST JOHN’S WORT: GETTING THE DOSE RIGHT
Posted on December 9, 2009, under Anti Depressants-Sleeping Aid.
Since the target dosage in most of the anti-depressant studies of mild-to-moderate depression has been 900 mg of Hypericum per day, this is a reasonable dose to aim for. The Kira brand of St John’s Wort which, for reasons that I discuss later, is the one I recommend most highly, comes in only 135-mg dosage, at least in the UK, which would mean taking about six 135-mg pills every day. Whenever I start an anti-depressant, I always begin with a low dose and increase the dosage somewhat gradually until the final or target dose is reached. The reason for this is that some people are very sensitive to medications and it is often not possible to predict who will be very sensitive and who will not. An average dose of an anti-depressant may be far too much for such a person to tolerate, especially when just beginning the medication. If a highly sensitive person starts right out with an ‘average’ dose of an anti-depressant without building up to the final target dosage, unpleasant side-effects may result and the person may be disinclined ever to try the medication again. So I would rather err on the side of moving a little too slowly. In practice, this means that I start a person on 300 mg (approximately two 135-mg pills) of Hypericum once a day for two or three days, then twice a day for two or three days, then three times a day. In older people, say over 60,1 would proceed even more gradually.
If unpleasant side-effects should develop, I slow down this progression, always working within the patient’s comfort zone. In other words, if you are uncomfortable with two 135-mg tablets of
Hypericum per day, don’t move up on the dosage until the side-effects dissipate, as they generally will. Be sure to listen to what your body is telling you. Discomfort of any sort is a signal for you to slow down. In some sensitive people, including the elderly, a final dose of less than 900 mg, such as 600 mg (4 x 135 mg), may work best.
I should note that my practice of starting slowly differs from the widespread practice in Germany of starting with 900 mg per day – approximately two Kira tablets three times a day. According to my German colleagues, they do not experience problems with this approach.
Be sure to take the Hypericum with meals, as this minimizes the chances of developing indigestion or abdominal discomfort which may occur in certain people on the herbal remedy.
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SUGGESTIONS FOR THOSE WHO ARE STRESSED OR FEELING MILDLY BLUE, DOWN IN THE DUMPS OR UNDER THE WEATHER
Posted on December 9, 2009, under Anti Depressants-Sleeping Aid.
An old advertisement for an over-the-counter cold medication observed that you can’t take every cold to a doctor, and proceeded to plug the medicine in question. The advert was right. It is not sensible to go to the doctor with every cold – or, for that matter, whenever you feel blue, down in the dumps or lacking in energy and pep. On the other hand, a case of pneumonia should always be taken to a doctor – and promptly – and that applies to serious depression as well. And just as we have guidelines to help us distinguish between a cold and pneumonia, so we can distinguish between serious depression and feeling mildly out of sorts. In the mildly blue, stressed-out, under-the-weather category, I would put those whose symptoms are not seriously interfering with their work, personal relationships or other aspects of their functioning. Also, the problem should not have been going on for too long, not more, say, than for a couple of months.
If you think you qualify for this very mild category, I suggest that you read about the symptoms of depression anyway because depressed people are often not very good at recognizing how depressed they are – and they are not alone in this regard. Statistics indicate that even doctors fail to recognize and treat depression properly in a very high proportion of cases. If professionals underestimate depression to this extent, lay people can surely be forgiven for doing the same. Because many of the symptoms of depression do not actually involve sadness or depressed mood, but rather physical symptoms, they are easily attributed to other conditions. In addition, depressed people often believe that their problems are due exclusively to influences from the outside world rather than some internal problem. This set of beliefs may be associated with a fear of acknowledging that ‘there may be something wrong with me’ and a pessimism about being able to correct the problem. In fact, the opposite is often true as it may be easier to correct problems that stem from within yourself than those that arise in the outside world, over which you may have very little control.
If, after reflection, you still feel that you are not clinically depressed, but simply overstressed or mildly down in the dumps, you may well benefit from a trial of St John’s Wort as described below. It is always important, of course, to address any underlying causes of your unhappiness in addition to taking the herbal remedy.
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